Surgical Repair of Cervical Aortic Arch With Brain Circulation Anomaly Through Clamshell Incision Toshihito Gomibuchi, MD, Tatsuichiro Seto, MD, Takateru.

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Surgical Repair of Cervical Aortic Arch With Brain Circulation Anomaly Through Clamshell Incision Toshihito Gomibuchi, MD, Tatsuichiro Seto, MD, Takateru Yamamoto, MD, Ko Nakahara, MD, Noburo Ohashi, MD, Yoshinori Ohtsu, MD, Yuko Wada, MD, Daisuke Fukui, MD, Kenji Okada, MD The Annals of Thoracic Surgery Volume 104, Issue 3, Pages e235-e237 (September 2017) DOI: 10.1016/j.athoracsur.2017.03.075 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Preoperative computed tomographic angiogram showing a cervical aortic arch, diverticulum, and right subclavian artery aneurysm. (B) Preoperative computed tomographic angiogram showing a brain circulation anomaly. Aplasia of bilateral internal carotid arteries and the right vertebral artery is evident. The Annals of Thoracic Surgery 2017 104, e235-e237DOI: (10.1016/j.athoracsur.2017.03.075) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Skin incision. (B) Intraoperative photograph shows the recurrent laryngeal nerve and the aneurysm of ductus arteriosus. We could get a superior exposure through a clamshell incision. (C) Schema of intraoperative photograph. The Annals of Thoracic Surgery 2017 104, e235-e237DOI: (10.1016/j.athoracsur.2017.03.075) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Postoperative computed tomographic angiogram. Postoperative computed tomography showed that the aortic arch was replaced with the prosthetic branched graft and was repaired with stent graft. The Annals of Thoracic Surgery 2017 104, e235-e237DOI: (10.1016/j.athoracsur.2017.03.075) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions